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Doctor says killer TB strain likely widespread

A doctor who discovered what he called a superbug says it appears to attack new HIV victims and make them "untreatable."

By ASSOCIATED PRESS
Published September 10, 2006

TUGELA FERRY, South Africa - A deadly new strain of extremely drug-resistant tuberculosis discovered in South Africa is likely to have spread beyond the rural area where 52 of the 53 people diagnosed with it have died, the doctor who discovered the superbug said.

The extent of the outbreak in the Kwazulu-Natal region of eastern South Africa is unknown because tests are expensive and specialized, said Dr. Tony Moll.

Moll identified the strain in tests carried out at King George V Hospital in Durban, the provincial capital about 150 miles southeast of Tugela Ferry, where he works at a government hospital.

"Most hospitals don't have such facilities and support," Moll told the Associated Press in an interview last week.

Extremely drug-resistant TB has been identified among highly mobile miners and probably can be found all over the country, Moll said.

"In some of the mines, they have identified (extremely drug-resistant TB) and, because our population is so mobile, if you looked in other provinces, no doubt you will find" the new strain, he said.

The World Health Organization issued a warning at a news conference in London on Friday, and said people could be dying in places that don't have the capacity to diagnose patients.

WHO classified the strain as extremely drug-resistant, saying drugs from two of the six medicines used as a last line of defense against TB proved ineffective against the new strain.

Drug resistance is a common problem in TB treatment, but the new strain appears particularly virulent. Worldwide, about 2 percent of drug-resistant TB cases are classified as extremely drug-resistant.

Moll found only a few cases in thousands of people tested but said the strain was "very highly troubling and alarming because of the very high fatality rate."

TB has been on the rise because AIDS has lowered so many South Africans' ability to fight it and other infections. All 53 patients who had extremely drug-resistant TB tested positive for HIV or were suspected positive, Moll said.

The government estimates more than 5.5-million of the 44-million South Africans are HIV-positive, second only to India. On average, more than 900 people die of the disease each day in South Africa.

A high illiteracy rate and poor adherence to the grueling six-month regimen of medication that can cure TB has in turn fueled a crisis with drug-resistant TB in South Africa.

Moll said that his Church of Scotland Hospital, founded by missionaries and now government-run, has 1,300 people on antiretrovirals but that there probably are 10,000 or 12,000 in the community going untreated for many reasons, including the stigma attached to AIDS.

Moll said he could treat as many people as asked, with the only constraint being a shortage of personnel. He is the only doctor prescribing antiretrovirals to adults in an area covering 650 square miles and regularly works at least 12 hours a day.

The doctor, who has worked at the hospital 20 years, said he became suspicious when AIDS patients responded well to antiretrovirals but died rapidly.

Further tests showed the TB strain was drug-resistant. Sixty percent of the patients had never had TB before, so had no history of failing to complete the course of medication, which usually leads to resistance. The patients came from all over the district.

"What actually happened here at Tugela Ferry is what we call a true outbreak ... one single bug that was fingerprinted and that was transmitted," he said. "These people caught TB for the first time and were infected by a superbug that was already resistant to this whole spectrum of medication ... making them practically untreatable."

He said it appeared to attack newly compromised HIV victims. Some patients had been previously hospitalized and could have caught the bug in the hospital, he said. At least two were hospital health workers.

Officials from the World Health Organization, the South African Development Community and the U.S. Centers for Disease Control and Prevention will meet in South Africa this week to discuss how to confront the threat posed by drug-resistant TB.

Conference organizers said such cases were increasing in Botswana, Mozambique and South Africa. And they warned that the extremely drug-resistant strain was becoming "a major threat to successful HIV treatment and care in sub-Saharan Africa."

South Africa's Health Department said Tuesday it was monitoring "the magnitude of the problem" of extremely drug-resistant TB in KwaZulu-Natal, and making plans to extend surveillance to other provinces.

"The solution to this problem is to prevent the development of such resistant strains by ensuring that people are treated properly right from the beginning and that they complete the treatment," the Health Department said.

There was concern the South African government, which has come under sharp criticism for its response to the AIDS crisis, considered the TB issue sensitive.

Last week, the government banned Health Ministry officials from talking to the media about AIDS. It seemed that ban might have been expanded to include TB this week. An AP interview with doctors treating extremely drug-resistant TB at King George V Hospital was canceled at the last minute by health officials.

U.S.-based AIDS activists, including a Yale University doctor who co-wrote Moll's study, said they were prevented Wednesday from making a long-planned video at the Tugela Ferry hospital.

Zackie Achmat, a South African AIDS activist, on Wednesday accused South African officials of being in "psychological denial" about the AIDS and TB epidemics "at the cost of people's lives."

International scientists, AIDS activists and South African opposition parties have accused Health Minister Manto Tshabalala-Msimang and President Thabo Mbeki of ignorance and poor judgment in addressing the AIDS epidemic.